College of Nurses of Ontario v. Blaney, 2016 ONCNO 104251

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

PANEL:

Robert MacKay, Chairperson Public Member

Dawn Cutler, RN Member David Edwards, RPN Member Shiraz Irani, RN Member

Mary MacMillan-Gilkinson Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) BONNI ELLIS for

) College of Nurses of Ontario

• and - )

MARGARET A. BLANEY ) SELF- REPRESENTATION for Registration No. 08351598 ) Margaret A. Blaney

) Heard: November 29, 2016

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (“the Panel”) on November 29, 2016 at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

Counsel for the College advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1(a), 1(b), 1(c), 2(a)(ii), 2(a)(iii), 2(b)(i), 2(b)(ii), 2(b)(iii), 2(b)(vi), 2(b)(viii), 2(b)(ix), 2(b)(x), 2(b)(xi), 2(b)(xii), 3(a)(ii), 3(a)(iii), 3(b)(i), 3(b)(ii), 3(b)(iii), 3(b)(vi), 3(b)(viii), 3(b)(ix), 3(b)(x), 3(b)(xi) and 3(b)(xii) of the Notice of Hearing dated October 25, 2016. The Panel granted this request.

The remaining allegations against Margaret A. Blaney (the “Member”) are as follows.

IT IS ALLEGED THAT:

1. [withdrawn]:

2. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in paragraph 1(1) of Ontario Regulation 799/93 in that, from about July to November 2014, while working as a Registered Nurse at the Brantford Jail, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession when you:

a. entered into personal and/or romantic relationship with [the Client], an inmate at the Brantford Jail, which included;

i. communicating with [the Client] in person, via letter and/or via phone;

ii. [withdrawn];

iii. [withdrawn]; and/or

iv. sending letters to [the Client]

b. brought various items to[the Client], an inmate at the Brantford Jail, which included;

i. [withdrawn];

ii. [withdrawn];

iii. [withdrawn];

iv. a Blackberry cellphone;

v. cellphone charger(s);

vi. [withdrawn];

vii. cellphone battery(ies);

viii. [withdrawn];

ix. [withdrawn];

x. [withdrawn];

xi. [withdrawn]; and/or

xii. [withdrawn].

3. You have committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in paragraph 1(37) of Ontario Regulation 799/93 in that, from about July to November 2014, while working as a Registered Nurse at the Brantford Jail, you engaged in conduct that having regard to all the circumstances would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional and, in particular, you:

a. entered into personal, romantic and/or sexual relationship with [the Client], an inmate at the Brantford Jail, which included;

i. communicating with [the Client] in person, via letter and/or via phone;

ii. [withdrawn];

iii. [withdrawn]; and/or

iv. sending letters to [the Client]

b. brought various items to [the Client], an inmate at the Brantford Jail, which included;

i. [withdrawn];

ii. [withdrawn];

iii. [withdrawn];

iv. a Blackberry cellphone;

v. cellphone charger(s);

vi. [withdrawn];

vii. cellphone battery(ies);

viii. [withdrawn];

ix. [withdrawn];

x. [withdrawn];

xi. [withdrawn]; and/or

xii. [withdrawn].

Member’s Plea

The Member admitted the allegations set out in paragraphs 2(a)(i), 2(a)(iv), 2(b)(iv), 2(b)(v), 2(b)(vii), 3(a)(i), 3(a)(iv), 3(b)(iv), 3(b)(v) and 3(b)(vii) in the Notice of Hearing. The Panel received a written plea inquiry which was signed by the Member. The Panel also conducted an oral plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

Counsel for the College advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads as follows.

THE MEMBER

1. Margaret A. Blaney (the “Member”) obtained a degree in nursing from Humber College in 2008.

2. The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on June 9, 2008.

3. The Member was employed at Brantford Jail (the “Facility”) from May 2014 to November 6, 2014.

THE FACILITY

4. The Facility is located in Brantford, Ontario.

5. The Member worked as a part-time staff nurse at the Facility. Her duties included conducting health assessments for new inmates and administering medications during rounds.

THE CLIENT

6. [The Client] was 29 years old at the time of the incidents described below.

7. The Client was transferred to the Facility from Maplehurst Correctional Centre on July 28, 2014. At the time, his medical history included pericarditis, myocardial infarction and pseudo seizures. He was taking ibuprofen, colchicine and Pantaloc.

8. The Member provided nursing care to the Client, which included the administration of prescribed and prn medications on several occasions between August and October 2014.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Providing Contraband to [the Client]

9. On October 23, 2014, [the Former Inmate] at the Facility, informed [the Corrections Officer] that he had been contacted by the Client via a cell phone with a “519” area code telephone number.

10. [The Former Inmate] said the Client told him he got the phone and the charger from a blond nurse at the Facility.

11. On October 24, 2014, a search was conducted and an LG flip phone as well as a phone charger and batteries were recovered. The telephone number for the LG phone was a “226” area code.

12. When the Client was questioned on November 5, 2014, he denied that the Member provided him with the LG flip phone. However, he told the Facility that the Member supplied him with her old cell phone, which was a Blackberry. She also gave him a cell phone charger and batteries for the Blackberry phone. The Blackberry was activated with internet capabilities. The Client said he smashed the Blackberry into pieces, which he flushed down a toilet, to avoid being caught in the search.

13. Inmates are strictly prohibited from having cell phones in the Facility. The rationale for the prohibition was described by the Deputy Superintendent of the Ministry of Community and Correctional Services as follows:

Having cell phones in the unit allows inmates to call out, make arrangements to bring drugs in. So to bring those cell phones in to an inmate put the entire inmate population at risk. It is considered very, very serious.

14. The Member acknowledges that, by providing the Client with the Blackberry cell phone, charger and batteries, she put the Facility’s staff and inmates at risk.

Relationship with [the Client]

15. The Member also entered into a personal and romantic relationship with the Client.

16. The Member provided the Client with both her cell phone number and her home phone number, after she hooked up a land line to facilitate calls from the Client.

17. The Client and the Member spoke on the phone on a regular basis. The Client used the Blackberry cell phone the Member provided him, as well as a telephone available to inmates on a limited basis at the Facility, to call the Member at home and to do three-way calls to speak to her on her cell phone.

18. Phone records from the Facility telephone indicate that the Client placed 84 calls to the Member’s home phone number between October 25 and November 6, 2014. Of those calls, 43 were “accepted.” Calls from the Facility were made “collect” and therefore had to be accepted. Most of the calls lasted between eight and 20 minutes, which was the maximum time allowed for inmate calls.

19. The Member and the Client also corresponded by letter. Mail logs confirm that on October 6, 7, and 8, 2014, the Client sent letters to the Member’s home address, which were addressed to a fictitious person as a means of concealing that he was writing to the Member.

20. In return, the Member hand-delivered letters to the Client, covered in lipstick and perfume, while doing medication administration rounds. The Member passed the letters to the Client when the Corrections Officer accompanying her on rounds was not looking.

21. On one occasion, the Member wrote to the Client:

I loved that letter. It was so hot! You described us being together as I imagined it would be. Love how you had the whole evening planned out for us too. Can’t wait until we’re able to spend together. I want to be able to tell you what I’m thinking and feeling, just as I am now. I love that you told me that I am your rock. I have NEVER been told that…

22. She also wrote:

I love the way you love me unconditionally, for who I am not for what I’d offer, not just for the sex, not for where/what you could be by being with me. You love me for me. I’ve waited for a man like you forever…I’m not letting go. I wake each morning feeling your love in my life, even without your physical presence. I feel so blessed to have found you, so blessed to have you love each and every day.

23. The Member signed the letter, “I love you forever and always babe. Hugs and kisses, your wife.”

24. The Client also sent the Member flowers and had lunch delivered to the Member at the Facility.

25. During interviews with the Facility, the Client stated that he was using the Member for his own purposes. For example, the Client told the investigator:

…and then it started with the fucking I love you’s and so on and so forth and…and I’m like holy fuck like this girls a fucking lonely fucking you know middle aged woman that’s just looking for a fucking, somebody to throw her attention and that’s what I, it’s wrong but I grabbed onto it and I ran with it.

26. If the Member were to testify, she would say that the Client was manipulative and took advantage of her in order to further his own interests. However, the Member acknowledges that it was her responsibility as a nurse to establish and maintain professional boundaries with the Client, which she failed to do.

COLLEGE STANDARDS

27. The College’s Therapeutic Nurse-Client Relationship Standard (“the Standard”) places the responsibility for establishing and maintaining the limits or boundaries in the therapeutic nurse-client relationship on the nurse.

28. The Standard states:

[c]rossing a boundary means that the care provider is misusing the power in the relationship to meet his or her personal needs rather than the needs of the client, or behaving in an unprofessional manner with the client.

29. The Standard further clarifies that a nurse may cross a boundary in a number of different ways, including:

• self-disclosure that does not meet a specified therapeutic client need;

• failing to ensure that the nurse-client relationship promotes the well-being of the client and not the needs of the nurse;

• giving gifts to the client or engaging in other behaviour that suggests a special relationship between the nurse and the client; and

• entering into a personal or romantic relationship with a client

ADMISSIONS OF PROFESSIONAL MISCONDUCT

30. The Member admits that her relationship with the Client, as described above in paragraphs 9 to 24, breached the College’s Therapeutic Nurse-Client Relationship Standard as alleged in the following paragraphs of the Notice of Hearing:

• 2(a)(i) and (iv)

• 2(b)(iv), (v) and (vii)

31. The Member also admits that she committed the acts of professional misconduct as alleged in paragraphs 3(a)(i) and (iv) and 3(b)(iv), (v) and (vii) of the Notice of Hearing, and in particular, her conduct was dishonourable and unprofessional, as described in paragraphs 9 to 23 above.

OTHER

32. With leave of the Panel of the Discipline Committee, the College withdraws the following allegations from the Notice of Hearing:

• 1

• 2(a)(ii) and (iii)

• 2(b)(i), (ii), (iii), (vi), (viii), (ix), (x), (xi), (xii)

• 3(a)(ii) and (iii)

• 3(b) (i), (ii), (iii), (vi), (viii), (ix), (x), (xi), (xii)

Decision

The Panel found that the Member committed acts of professional misconduct as alleged in paragraphs

2(a)(i), 2(a)(iv), 2(b)(iv), 2(b)(v), 2(b)(vii) of the Notice of Hearing. As to allegation 3(a)(i), 3(a)(iv), 3(b)(iv), 3(b)(v) and 3(b)(vii), the Panel found that the Member engaged in conduct that would reasonably be considered by members to be dishonourable and unprofessional.

Reasons for Decision

The Panel considered the Agreed Statement of Facts and the Member’s plea and found this evidence supports findings of professional misconduct with respect to the remaining allegations in the Notice of Hearing.

Allegation #2 (a)(i) in the Notice of Hearing is supported by paragraphs 10, 12, 14, 16-23, and 27-29 in the Agreed Statement of Facts.

Allegation #2(a)(iv) in the Notice of Hearing is supported by paragraphs 19-23 and 27-29 in the Agreed Statement of Facts.

Allegation #2(b)(iv) in the Notice of Hearing is supported by paragraphs 10, 12, 14, 16, 17 and 27-29 in the Agreed Statement of Facts.

Allegation # 2(b)(v) in the Notice of Hearing is supported by paragraphs 10, 12, 14 and 27-29 in the Agreed Statement of Facts.

Allegation #2(b)(vii) in the Notice of Hearing is supported by paragraphs 12, 14 and 27-29 in the Agreed Statement of Facts

There was clear evidence that the standards of practice addressed in the published Therapeutic Nurse-Client Relationship standard were breached by the Member in multiple ways. Public safety was put at risk. As the Member herself has acknowledged, it is not a defence that the Client might have manipulated the Member for his own purposes. The obligation is on nurses to set and enforce boundaries.

Allegation #3(a)(i), 3(a)(iv), 3(b)(iv), 3(b)(v) and 3(b)(vii), relied on the same facts as for Allegation #2. The Panel found that the Member’s conduct was unprofessional as she demonstrated poor judgement when she entered into a personal and romantic relationship with a Client. Her actions showed a serious and persistent disregard for her professional obligations. The Panel also found that the Member’s conduct was dishonourable in that she used deceit and dishonesty to hide the letters and objects that she surreptitiously gave to the Client.

In light of the allegations before the Panel, the Panel did not consider whether any of the conduct could be considered as behaviour or remarks of a sexual nature.

Penalty

Counsel for the College and the Member advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission invited this Panel make an order as follows.

1. Requiring the Member to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

2. Directing the Executive Director to suspend the Member’s certificate of registration for four months. The suspension shall take effect from the date that this Order becomes final and shall continue to run, without interruption, as long as the Member remains in the practising class.

3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend two meetings with a Nursing Expert (the “Expert”), at her own expense, and within six months from the date that this Order becomes final. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least seven days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires, online learning modules and online participation forms (where applicable):

1. Professional Standards,

2. Therapeutic Nurse-Client Relationship,

iv. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into her behaviour;

vii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration;

b) For a period of 12 months from the date the Member’s suspension ends, the Member will notify her employers of the Panel’s decision. To comply, the Member is required to:

i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

ii. Provide her employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, confirming :

1. that they received a copy of the required documents, and

2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. All documents delivered by the Member to the College, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Penalty Submissions

College Counsel submitted that the Joint Submission on Order is in the public interest and that it is in the range of orders for similar conduct in previous cases. College Counsel acknowledged that no cases are the same. She reminded the Panel that the Joint Submission on Order should meet the purposes of specific deterrence, general deterrence, remediation and public protection. It should inspire confidence in the public. She submitted that the Panel should only reject the Joint Submission if it were contrary to public interest and if it would bring the administration of justice into disrepute.

The Member was given an opportunity to address the Joint Submission on Order. She stated that she took full responsibility for her actions. She emphasized that there had been no physical contact between her and the Client. She said that she quit her position once she realized the situation. College Counsel responded by reminding the Panel to refer to the Agreed Statement of Facts when making our decision.

The parties agreed that the mitigating factors in this case were:

(a) this is the first time that the Member has been before a panel of the Discipline Committee,

(b) the Member has admitted to the allegations and has taken responsibility for her actions,

(c) the Member has saved the College time and financial resources by eliminating the need for a contested hearing, and

(d) the Member has saved witnesses the unpleasantness and inconvenience of testifying.

They also agreed the primary aggravating factor in this case was that the Member put the Facility at risk when she provided the Client with a Blackberry cell phone and charger.

The proposed penalty provides for general deterrence in that it sends a strong message to members that they need to consistently maintain their professional boundaries in all professional settings.

The proposed penalty provides for specific deterrence, remediation, and rehabilitation through the reprimand and terms, conditions and limitations to the Member’s certificate.

Overall, the public is protected because this process provides the Member with the opportunity to gain additional insight into her practice requirements and learn how she can better fulfill them in the future.

College Counsel submitted three cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee.

In CNO v. Edwards (Discipline Committee, 2012), the member breached his professional boundaries by complimenting and inappropriately touching a vulnerable client in the psychiatric facility where he worked. He received a suspension of two months and was required to have three meetings with a nursing expert. In CNO v. Parke (Discipline Committee 2012), the member had a personal relationship with a client post discharge. He received a five month suspension. In the case of CNO v. Odumeru (Discipline Committee 2011), the member communicated with a client post discharge. The communications were confined to texts, emails and phone conversations. The member received a two month suspension.

Penalty Decision

The Panel accepted the Joint Submission as to Order and accordingly ordered:

1. The Member is required to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

2. The Executive Director is directed to suspend the Member’s certificate of registration for four months. The suspension shall take effect from the date that this Order becomes final and shall continue to run, without interruption, as long as the Member remains in the practising class.

3. The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a. The Member will attend two meetings with a Nursing Expert (the “Expert”), at her own expense, and within six months from the date that this Order becomes final. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least seven days before the first meeting, the Member provides the Expert with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires, online learning modules and online participation forms (where applicable):

1. Professional Standards,

2. Therapeutic Nurse-Client Relationship,

iv. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms;

v. The subject of the sessions with the Expert will include:

1. the acts or omissions for which the Member was found to have committed professional misconduct,

2. the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,

3. strategies for preventing the misconduct from recurring,

4. the publications, questionnaires and modules set out above, and

5. the development of a learning plan in collaboration with the Expert;

vi. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

1. the dates the Member attended the sessions,

2. that the Expert received the required documents from the Member,

3. that the Expert reviewed the required documents and subjects with the Member, and

4. the Expert’s assessment of the Member’s insight into her behaviour;

vii. If the Member does not comply with any one or more of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration;

b. For a period of 12 months from the date the Member’s suspension ends, the Member will notify her employers of the Panel’s decision. To comply, the Member is required to:

i. Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

ii. Provide her employer(s) with a copy of:

1. the Panel’s Order,

2. the Notice of Hearing,

3. the Agreed Statement of Facts,

4. this Joint Submission on Order, and

5. a copy of the Panel’s Decision and Reasons, once available;

iii. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, confirming :

1. that they received a copy of the required documents, and

2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

3. All documents delivered by the Member to the College, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public confidence in the ability of the College to regulate nurses. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation. The Panel also considered the penalty in light of the principle that joint submissions should not be interfered with lightly.

The Panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility. The Panel found that the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection. Members of the profession will be reminded that the obligation to enforce therapeutic and professional boundaries is always on the nurse.

I, Robert MacKay, Public Member, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel as listed below:

Chairperson Date

Panel Members:

Robert MacKay, Public Member, Panel Chair

Dawn Cutler, RN

David Edwards, RPN

Shiraz Irani, RN

Mary MacMillan-Gilkinson, Public Member